Wednesday, March 26, 2008

The always informative Lisa Chedekel filed another statistic-rich report for the Hartford Courant earlier this month that I've been wanting to share with you. In it, she lists the results of a recent study, a 205-question survey developed by Drs. Marc Goldstien and James Malley, conducted by the state of Connecticut examining the health and reintegration needs of their 11,000 returning troops:

A first-ever survey of returning state troops shows that at least one-quarter of them meet the diagnostic criteria for post-traumatic stress disorder, while many cite problems with a spouse or partner and difficulties "connecting emotionally with family" as major concerns.

A state mental health hot line [866-251-2913] has fielded more than 300 calls for assistance from Iraq and Afghanistan veterans and their family members in the past nine months. Recently, the state veterans' affairs commissioner has begun working with the courts to ensure that increasing numbers of recently returned troops who are arrested for domestic violence, drunken driving or other offenses are flagged and referred to counseling programs.

"There's a lot of real high risks here — not only for the military members themselves, but for their families," said Linda Schwartz, commissioner of the state Department of Veterans' Affairs. "We have people in almost every town in our state who have served deployments, and the VA is just not going to be able to get to them all. We have to do more to reach out to them … to catch them when they fall."

“This is a different type of warfare that is creating new issues and stresses on our veterans and their families,” said Governor Rell. “We cannot wait ten or twenty years to begin planning how best to take care of this latest generation of heroes. We must be proactive in determining their needs now. This study is an important step forward in that effort.” ...

“We waited too long during the Vietnam-era to prepare for the extensive needs of those who served their country. We cannot make that mistake again,” said Dr. Linda S. Schwartz, commissioner of the Department of Veterans Affairs and a Vietnam veteran. “I strongly encourage all those veterans who have received this needs assessment to take the time to register their voice by completing and returning this survey. You can help make a difference in your future.”

“Your experience – and the experience of your family – is important to help us develop meaningful legislation, services and programs,” Governor Rell wrote in a letter to all veterans who received the needs assessment. “It is important we hear from you in order to accurately understand your problems, issues and needs in order to put in place the programs and support you may need in the future. It is critical to identify potential gaps in the support systems for veterans early on – so Connecticut will provide the best for you and future generations of service members.”

Preliminary findings of a survey sent to 1,000 Connecticut troops who served in Iraq and Afghanistan — more than half in the National Guard or reserves — found that about 19 percent met criteria indicating they are at risk of traumatic brain injury, while at least 24 percent met the diagnostic criteria for PTSD. Schwartz said the percentage of troops who are experiencing symptoms of PTSD is likely higher than the rate captured in the survey, which used strict criteria.

The study also suggests that troops are reluctant to seek counseling from mental health professionals, with a large proportion of respondents saying they have sought psychological help from primary care doctors or emergency rooms. About half reported that their general health was "much worse" or "somewhat worse" than before they were deployed to war.

The state-funded study — conducted by Central Connecticut State University's Center for Public Policy and Social Research, with assistance from the Yale School of Medicine — identified several key areas of concern among the returning troops, among them: a sense of being disconnected from their community; trouble communicating with everyone except fellow veterans; feelings of being "tightly wound" or "aggressive"; and a reluctance to seek psychological help, for fear of being stigmatized or perceived as weak.

Last October, Central Connecticut hosted an all-day summit on veterans issues convened by Gov. Rell and Wesley Strong wrote of the gathering in the university's paper:

The event, which took place last Friday, included two sessions where about 300 participants broke into focus groups to work on specific issues from healthcare to women veterans’ issues. Each group consisted of several experts from the Department of Veteran’s Affairs and veteran community, and was geared towards discussing the problems in each one’s topic.

Recommendations compiled by the groups included proactive education of benefits to the soldiers, more communication between the Department of Defense and Veteran’s Affairs, and greater access to services during times that would not interfere with work. ...

The summit also included a report of preliminary findings from a study run by veterans from Operation Enduring Freedom and Operation Iraqi Freedom. The study conducted by Dr. Marc Goldstien and Dr. James Malley in coalition with the CCSU Center for Social Research and Public Policy compiled data from focus groups and over 200 surveys.

The data found that many veterans were reluctant to get help. Over 60 percent of those who had shown signs of PTSD had not sought help. Dr. Malley said that in the focus groups some troops had found it easier to stay in combat than to come home.

Emily Beaver at the Waterbury Republican-American introduces us to one veteran who participated in the summit:

When Sgt. Matt Talbot returned to Connecticut in 2006 after serving in Iraq with the Marine Corps, he had tension in his shoulder, bone chips in his ankle and anxiety. But Talbot, now a full-time business student at Northwestern Connecticut State University, has to travel 50 minutes from his home in Torrington to receive the care he needs at a VA hospital in Newington. Sometimes, he has to miss class to attend doctor's appointments, a choice 23-year-old Talbot said he doesn't want to make.

On Friday, he went to a summit at Central Connecticut State University to ask state officials how they plan to accommodate veterans like himself, who return from conflicts in Iraq and Afghanistan to face a health care system that can be difficult to navigate, benefits buried beneath mounds of paperwork and a community they don't seem to fit into anymore.

"I haven't had a negative experience, but there's room for improvement," Talbot said.

As an active duty soldier returning home from Iraqi [sic] in 2004, Joel Patrick Leger faced an experience shared by many veterans. He felt isolated, in need of someone to help him make the transition back to civilian life.

"I wish there was some type of peer support system, someone who I could have talked to from the same war theater," said Leger, 27, of East Windsor, who fought with the Army's 101st Airborne Division. ...

Participants found that heath care access differs in each branch of service, that a traumatic brain injury is often confused with post traumatic stress syndrome, that families of veterans need outside help and support, and that educational benefits are lacking for certain branches of the service. The groups all agreed on the need for better communication among veterans and state agencies and service providers.

Gary Knight, an Army veteran from Operation Iraqi Freedom who participated in the employment focus group, said that when he returned home in 2005 he didn't know that as a veteran he could get his driver's license renewed free of charge.

"I learned things word of mouth. There needs to be a better system, a briefing when you return," said Knight, 46, of Waterbury.

One more chunk of important information from the Chedekel piece:

Last spring, state agencies and the Connecticut National Guard launched a hot line [866-251-2913] and referral program that links returning troops and their family members with a network of trained community mental health providers. The program — funded with $1.3 million in state money — has received more than 315 calls and made 180 referrals.

State officials, concerned that troops with PTSD and other psychological problems are not seeking care, say they are hoping to draw more people to the program in the next year through outreach and advertising.

The survey findings indicate some adjustment problems for troops returning to jobs or enrolling in colleges. Almost 20 percent of respondents said that after being deployed, their civilian jobs were not as satisfying to them. Some who returned to colleges said they felt like outsiders on campus.

Schwartz said she has begun asking state colleges to establish "drop-in centers" where veterans can go to socialize with other veterans, to help ease the sense of isolation. ...

Some private sector efforts to help returning troops also are underway. The Hartford Financial Services Group, in collaboration with the Disability Management Employer Coalition, has produced a free guide [pdf] for employers that contains recommendations on helping returning troops re-integrate into the workplace. The recommendations include providing sensitivity training to managers about issues faced by civilian soldiers during and after deployments and providing mentoring programs to link returning troops with other veterans.

Employers can help America's heroes succeed in the workplace by offering employee assistance and mentoring programs, advised the Workplace Warrior Think Tank - the first-of-its-kind group launched by the Disability Management Employer Coalition (DMEC), the leading developer of employee health and productivity strategies, and three of the nation's leading disability insurers - The Hartford Financial Services Group, Inc. (NYSE: HIG), MetLife and Unum.

Today, the think tank is providing its recommendations to employers in a free guide, "Workplace Warrior: The Corporate Response to Deployment and Reintegration [pdf]." ...

"The U.S. military involvement in Iraq and Afghanistan has created long-term medical and disability issues for returning veterans. To retain these valuable employees and benefit from their knowledge, abilities and experience, a comprehensive response is needed by employers," said Marcia Carruthers, chief executive officer of DMEC and think tank co-chair.

"One effective way that employers can assist veterans is employing an Employee Assistance Program to tackle the major health, work and family challenges resulting from a lengthy overseas assignment in a combat zone," said Carol Harnett, vice president and national disability and life practice leader for The Hartford and co-chair of the Workplace Warrior Think Tank.

Another highly effective tool to support the successful reintegration of civilian soldiers is a mentoring program that links them with veterans within the workforce. The commonality of military experience may forge bonds among colleagues. "Virtually any employer can provide mentoring by other veterans - at any level and for very little cost," said think tank participant Andrew R. Gilbert, a military veteran who founded a forum at his employer Booz Allen Hamilton.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.

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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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